Best Practice
The incidence of hematoma following rhytidectomy remains significant despite a variety of preventative methods including drains, tissue sealants, tumescent infiltration, compression dressings, and pharmacologic interventions. Although definitive risk factors for hematoma formation have been identified, such as the presence of elevated preoperative systolic blood pressure and male gender, the occurrence of this complication is still largely random and unpredictable, which can be frustrating to both patient and surgeon.
Certainly, there is no replacement for meticulous surgical technique and adequate intraoperative hemostasis in reducing the risk of postoperative hematoma after rhytidectomy. If proper hemostasis is not achieved prior to closure, there is no drain or dressing that can reliably prevent postoperative complications from occurring.
The most commonly used adjunctive measures for minimizing the risk of hematoma formation in the postoperative setting are drain placement, application of tissue sealant, and use of compression dressings. In terms of drain use after facelift surgery, the majority of studies have failed to demonstrate a significant clinical benefit and do not support their routine use. The highest quality investigation, a prospective trial from 2007, did show a reduction in bruising with drain placement that the authors surmise may lead to more rapid return to regular activities and therefore greater patient satisfaction. When contemplating drain placement following rhytidectomy, this may be a factor to be considered against the potential downsides of this practice.
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